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- W3140011700 abstract "Introduction: The first variant reported was Tourniquet-ALPPS (T-ALPPS), which occludes the intrahepatic circulation by means of a tourniquet around the liver. Methods: We present a modification of our surgical technique, T-ALPPS, named “partial Tourniquet-ALPPS” (pT-ALPPS) which avoids the pass of the tourniquet by hanging maneuver and the right extraglissionan approach. The first Stage of this variant is easier, quicker and less risky compared to ALPPS, p-ALPPS or T- ALPPS. Results: In our HBP unit 65 T-ALPPS have been performed. Since February 2017 we underwent a prospective study comparing T-ALPPS with pT-ALPPS, including 6 patients with colorectal liver metastases (CRLM) in each group. The first case of pT-ALPPS, was performed in a patient with bilobar metastases and one of them was located in segment, in front of the inferior vena cava thus the tourniquet could not be passed by hanging maneuver. After clearing the future liver remnant (FLR) of CRLM, we ligate the right portal vein. Considering that the ventral portion of the liver to the right portal pedicle is a non-vascularized area, and with the aid of intraoperative ultrasonography, an Adson clamp was passed through the liver parenchyma. This clamp emerged between the right and middle hepatic vein. A tourniquet was then passed and knotted under ultrasound control. In Stage 2, we used the tourniquet as hanging maneuver for right hepatectomy or right trisectionectomy depending on its location. Conclusion: In selected patients P-T-ALPPS is an accessible technique easier than T-ALPPS as the clamp passes through an avascular area." @default.
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- W3140011700 date "2021-01-01" @default.
- W3140011700 modified "2023-10-17" @default.
- W3140011700 title "The Least Aggressive ALPPS Variant: Partial-Tourniquet-ALPPS" @default.
- W3140011700 doi "https://doi.org/10.1016/j.hpb.2020.11.477" @default.
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